In Hong Kong, it’s cheaper to die in a nursing home than a hospital, study finds

Elizabeth Cheung
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In Hong Kong, it’s cheaper to die in a nursing home than a hospital, study finds

End-of-life care for people spending their last days in a nursing home costs almost a fifth less than for those who die in hospital, a study has found.

The findings prompted the head of the Elderly Commission, whose NGO did the study, to suggest officials consider offering more support for end-of-life care in residential homes.

The study, by Haven of Hope Christian Service, which offers various health care services including end-of-life care for the elderly, looked at cost incurred and time spent in hospitals during the final year of 169 elderly people. Those studied had stayed in the organisation’s nursing home in Tseung Kwan O between 2010 and last year.

Among them, 58 joined a scheme offered by the home allowing them to die there. The other 111 did not join and died in hospital.

End-of-life care options have become increasingly relevant as the city’s population ages. The government projected people aged 65 or older would account for 29.9 per cent of the population by 2038, up from 17 per cent this year.

The study found that the median total of end-of-life care costs for those who joined the scheme was 17 per cent, or HK$66,080, less than for those who did not join.The government projected people aged 65 or older would account for 29.9 per cent of the population by 2038

Based on estimates from other studies which showed every year about 5,250 nursing home residents preferred to die in those homes, the authors projected that if all those elderly people could spend their last days in nursing homes the government could save more than HK$340 million on end-of-life care per year.

Haven of Hope’s CEO Dr Lam Ching-choi, who also heads Hong Kong’s Elderly Commission and sits on the Executive Council, said medical costs for people who died in nursing homes were lower because of fewer days spent in hospital.

“With the support of a [multidisciplinary] team and the consent of a patient’s family to not resuscitate a person, the patient can stay in a nursing home to receive care,” Lam said. “As the cost in hospital is much higher than that of a nursing home, such differences could lead to reduced use of resources.”

With 93 per cent of deaths in Hong Kong occurring in hospitals, Lam said it was difficult for many Hongkongers to die in the way they want.

“Many elderly people want to leave the world peacefully in a familiar and tranquil environment,” Lam said. “[But] it is not easy to do that in Hong Kong.”

He said many care homes in the city were not designed to provide specific medical care for dying patients, and that the government could consider dedicating more money to supporting end-of-life care services in those nursing homes.

“More resources could be added to those nursing homes to hire more doctors and nurses, and offer end-of-life care training to those medical staff,” Lam said.

This upscale project is a model for housing Hong Kong’s elderly

A spokesman for the Food and Health Bureau said the government had set out in its policy agenda last year to “consider formulating a more robust policy and legislative framework to facilitate end-of-life care planning and the provision of palliative care outside hospital settings”. The policy agenda is a detailed supplement issued with the city’s chief executive’s annual policy address.

The bureau also commissioned Chinese University to study the quality of health care services for the ageing, which would recommend legislative proposals to improve end-of-life care services.

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